Director, Network Contracting
Director, Network Contracting
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Job Description
Who We Are
Point32Health is a leading not-for-profit health and well-being organization dedicated to delivering high-quality affordable healthcare. Serving nearly 2 million members Point32Health builds on the legacy of Harvard Pilgrim Health Care and Tufts Health Plan to provide access to care and empower healthier lives for everyone. Our culture revolves around being a community of care and having shared values that guide our behaviors and decisions. Weve had a long-standing commitment to inclusion and equal healthcare access and outcomes regardless of background; its at the core of who we are. We value the rich mix of backgrounds perspectives and experiences of all of our colleagues which helps us to provide service with empathy and better understand and meet the needs of the communities where we serve live and work.
We enjoy the important work we do every day in service to our members partners colleagues and communities. Learn more about who we are at Point32Health.
Job Summary
The Director of Contracting is responsible for contract strategy development negotiation and implementation for hospitals physician groups and integrated delivery systems across multiple markets and products. The Director will lead a team who negotiates contracts including risk arrangements to enable high performing provider networks that support goals for membership growth quality and financial performance. The Director will foster and maintain strong relationships with strategic providers to support achievement of shared plan and provider objectives.The Director is member of the leadership team and will be actively engaged in division strategy planning and performance initiatives. This role will manage a team of contract managers and will work in a matrix environment collaborating with functions including risk adjustment population health finance operations actuarial and sales.
Job Description
Key Responsibilities/Duties what you will be doing (top five):
Provider Network Strategy and Development
- Develop provider networks to meet goals for access membership quality medical cost and earnings. Build and maintain high performing provider networks utilizing risk-based structures and incentives whenever possible. Identify and recommend changes to networks as needed to advance business goals.
- Collaborate with VP and President to develop network strategies risk sharing and payment models and performance incentives to support achievement of cost and quality goals.
- Stay abreast of trends and changes in the industry provider landscape and federal and state payment policies and methodologies. Utilize this knowledge to refine and advance network development and performance.
Contract Negotiation and Management
- Direct a team of contract managers to negotiate financial operational regulatory and legal contract parameters with physician groups ACOs and hospitals to meet business goals and regulatory timelines.
- Coach support and train staff to devise proposals strategies and options for contract negotiation. Support contract negotiation as needed.
- Devise strategy lead and negotiate agreements with largest provider systems.
- Develop and maintain optimal provider networks. Assess monitor and manage network adequacy to meet federal and state regulations. Proactively identify and close network gaps.
- Collaborate with Enterprise Allied Health Contracting to ensure allied health and BH/SA networks and payment terms support Medicare division needs and goals. Assess and monitor allied payment rates and recommend changes to methodology and rates to align incentives and manage expense trends.
- Collaborate with colleagues in the Enterprise Network Operations to ensure timely and accurate contract implementation configuration and accurate ongoing contract administration.
Strategic Relationship Management
- Develop and implement a proactive relationship management approach that supports long-term mutually successful relationships with strategic providers.
- Engage with the provider performance team to understand and monitor provider and network performance. Advise on performance improvement plans and identify contract strategies and incentives that support performance improvement.
- Collaborate with operations professional relations and other functions to identify and resolve provider issues.
Stakeholder Engagement
- Proactively communicate and engage with function leaders and key stakeholders. Participate in/chair leadership meetings concerning provider strategy network development and other issues.
Talent Management and Team Building
- Provide ongoing staff development and coaching in negotiation performance analysis and relationship management to enable a high-performing team of provider professionals.
- Other duties and projects as assigned.
Qualifications what you need to perform the job
Certification and Licensure
Education
- Required (minimum): bachelors degree in business health care or related field.
- Preferred: Masters degree
Experience
- Required (minimum): 10-15 years of progressively responsible management experience in a complex healthcare setting. Experience in managed care contracting and experience working collaboratively with providers.
- Preferred: 10-15 years of Medicare Advantage experience.
Skill Requirements
- Energetic goal driven leader with a proven ability to deliver results and lead teams to achieve goals.
- Strong working knowledge of managed care/risk contracting payment methodologies.
- Savvy negotiator with experience in a range of provider payment methodologies including risk. Demonstrated experience in direct high-level negotiations with the proven ability to close a deal while maintaining relationships.
- Excellent quantitative skills with ability to synthesize financial information create and evaluate options.
- Excellent interpersonal skills and a high level of diplomacy to anticipate recognize and deal effectively with complex issues.
- Strong relationship skills to influence and work collaboratively with physicians and other provider leaders.
- Excellent management skills to guide inspire and develop a high performing team.
- Ability to manage and direct multiple priorities across markets while meeting aggressive deadlines.
- Adaptable to change and ambiguous situations; able to maintain constructive behavior in challenging situations. Requires the ability to think and plan strategically. Ability to assess and address interests of the enterprise and providers
- Strong collaborator able to work effectively across functions.
Working Conditions and Additional Requirements (include special requirements e.g. lifting travel):
- Must be able to work under normal office conditions and work from home as required.
- Work may require simultaneous use of a telephone/headset and PC/keyboard and sitting for extended durations.
- May be required to work additional hours beyond standard work schedule.
Disclaimer
The above statements are intended to describe the general nature and level of work being performed by employees assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities duties and skills required of employees assigned to this position. Management retains the discretion to add to or change the duties of the position at any time.
Compensation & Total Rewards Overview
As part of our comprehensive total rewards program colleagues are also eligible for variable pay. Eligibility for any bonus commission benefits or any other form of compensation andbenefits remains in the Companys sole discretion and maybe modified at the Companys sole discretion consistent with the law.
Point32Health offers their Colleagues a competitive and comprehensive total rewards package which currently includes:
Medical dental and vision coverage
Retirement plans
Paid time off
Employer-paid life and disability insurance with additional buy-up coverage options
Tuition program
Well-being benefits
Full suite of benefits to support career development individual & family health and financial health
For more details on our total rewards programs visit welcome all
All applicants are welcome and will receive consideration for employment without regard to race color religion gender gender identity or expression sexual orientation national origin genetics disability age or veteran status.
Scam Alert: Point32Health has recently become aware of job posting scams where unauthorized individuals posing as Point32Health recruiters have placed job advertisements and reached out to potential candidates. These advertisements or individuals may ask the applicant to make a payment. Point32Health would never ask an applicant to make a payment related to a job application or job offer or to pay for workplace equipment. If you have any concerns about the legitimacy of a job posting or recruiting contact you may contact
Required Experience:
Director
Employment Type
Full-Time
Key Skills
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